Zhi Wang

Objective: Accurate risk assessment for fatal diquat poisoning is critical to improving clinical outcomes. Therefore, this study aimed to evaluate the combined value of the multiple organ dysfunction syndrome (MODS) and neutrophil-to-lymphocyte ratio (NLR) in predicting in-hospital all-cause mortality from acute diquat poisoning. Methods: This work retrospectively enrolled diquat self-poisoning patients in Guangzhou 12th People’s Hospital between 2017 and 2023. Demographic, exposure, and 24-h laboratory data were extracted. A time-dependent Cox model evaluated MODS as a time-varying predictor. LASSO and logistic regression identified independent predictors and established the prediction equation; restricted cubic splines assessed dose-response. Bootstrap internal validation evaluated discrimination and calibration; however, variable selection was not repeated within each resample, and therefore the optimism-corrected performance metrics should be interpreted with caution. SHAP quantified feature contributions. Results: NLR was significantly elevated in non-survivors compared to survivors (median 31.37 vs. 11.19, P < 0.001). In the time-dependent Cox analysis, MODS remained independently associated with mortality (hazard ratio [HR] = 35.24, 95% CI: 13.57–91.50, P < 0.001). In the exploratory logistic regression, MODS (adjusted odds ratio [aOR] = 34.63, 95% CI: 7.47–245.65, P < 0.001), diquat dose (aOR = 1.34 per 10 mL, 95% CI: 1.22–1.63, P < 0.001), and NLR (aOR = 1.07, 95% CI: 1.02–1.13, P = 0.01) were independently associated with in-hospital all-cause mortality. The combined model achieved an AUC of 0.976 (Bootstrap 95% CI: 0.951–0.998), with an optimism-corrected AUC of 0.970, an apparent calibration intercept of 0, an apparent calibration slope of 1, and a Brier score of 0.0553 (95% CI: 0.0140–0.0775). SHAP values ranked feature importance as diquat dose (0.179) > MODS (0.145) > NLR (0.069). Sensitivity analyses confirmed the robustness of these findings. Conclusion: MODS and NLR were independently associated with in-hospital all-cause mortality in acute diquat poisoning. When applied after the first 24–72 h of admission, the combined model shows promise as a potential exploratory tool for risk stratification; however, external validation in larger multicenter cohorts is required before any consideration of bedside application.

Objective: Pesticide self-poisoning is a major global public health issue, yet the post-discharge mental health of survivors remains poorly characterized. To investigate the physical and mental health among survivors of diquat self-poisoning after returning to the community, which informs the effective prevention and intervention measures of repeated suicide. Methods: A follow-up study of 25 patients with acute diquat self-poisoning was enrolled from Guangzhou twelfth people’s hospital during 2017 to 2023. The health-related quality of life (HRQoL) was evaluated using the MOS 36-item short-form health survey (SF-36), and anxiety and depression were, respectively, assessed using Generalized Anxiety Disorder-7 (GAD-7) and Patient Health Questionnaire-9 (PHQ-9) scales. Results: Twenty-five (25) diquat self-poisoning patients were enrolled in a follow-up study, with a median follow-up of 1.58 person-years. Most participants had low scores in mental health of the HRQoL survey, with a median score was 108.15. In SF-36 domains, only Role Physical (RP) scored significantly lower in the high-dose group ( p = 0.04). Persistent neurological issues (fatigue, forgetfulness, headache) were the primary physical complaints. HRQoL total scores were significantly shaped by sleep duration, history of major trauma, left-behind child status, and psychological symptoms ( p < 0.05). Anxiety and depression symptoms had high prevalent rates of 56 and 68%, respectively. Stratified analysis by toxic dose [low-dose (≤ 50 mL, n = 12) vs. high-dose (> 50 mL, n = 13)] revealed no statistically significant differences in anxiety or depression rates. Conclusion: Diquat self-poisoning survivors may experience persistent physical and psychological health difficulties after returning to the community, warranting further attention. The findings highlighted that prevention of repeated self-harm is still necessary among at-risk populations after returning to the community, particularly adolescents and young adults.

Background: Selenium is an essential trace element widely used in health supplements. Reported cases of selenium poisoning have mainly involved hair loss, nail changes, and liver dysfunction, whereas toxic encephalopathy is uncommon. To date, no cases of selenium poisoning causing vision or hearing loss have been reported. Case Presentation: We report a 27-year-old woman employed in health supplement research and development who was occupationally exposed to multiple selenium compounds. During product testing in April 2025, she ingested selenium-containing samples. Based on the product formulation and the recorded amount sampled, the estimated oral selenium intake was 40.146 mg; however, this value represents an exposure estimate rather than a directly measured absorbed dose. She subsequently developed multisystem toxicity, including toxic encephalopathy, bilateral vision loss, hearing loss, liver dysfunction, alopecia, nail changes, and radial bone marrow edema. Initial symptoms were nausea and vomiting, followed by hearing loss, impaired consciousness, vision loss, and liver dysfunction. The first post-exposure blood selenium concentration was 13,131.8 ng/mL, and the urinary selenium concentration was 20,756.1 ng/mL. Intervention and Outcome: Treatment included sedation, diuretics, corticosteroids, hyperbaric oxygen therapy, organ protection, neurotrophic support, anti-infective therapy, and nutritional support. Consciousness recovered within 2 weeks, and liver function normalized. Vision transiently improved but later worsened. At 35-week follow-up, the right eye had no light perception, the left eye had visual acuity of 20 cm, and hearing loss had progressed to complete deafness. Conclusion: Extremely high-dose selenium ingestion can cause toxic encephalopathy and previously unreported persistent vision and hearing loss. Early supportive treatment and measures promoting selenium elimination may improve some clinical outcomes.

Objective: This cross-sectional study aimed to investigate the associations between dietary factors and morbidity burden among occupational radiation workers in Guangzhou, China, a population with chronic low-dose radiation exposure. Methods: From January to December 2024, 1,080 medical radiation workers were enrolled. Dietary intake was assessed using a validated food frequency questionnaire, and morbidity burden was defined as the presence of clinically diagnosed chronic conditions. Multivariable logistic regression models were employed to evaluate associations, adjusting for demographic, occupational, and lifestyle confounders. Results: The overall morbidity prevalence was 45.5%, with thyroid diseases being most common (23.5%). Significant dietary differences were observed: higher tea consumption (≥3 times/week: OR 0.41, 95% CI 0.26 ~ 0.64), vegetable intake (≥3 times/week: OR 0.44, 95% CI 0.29 ~ 0.67), and fruit consumption (≥200 g/week: OR 0.71, 95% CI 0.53 ~ 0.95) were associated with lower morbidity odds. In contrast, high red meat intake (≥3 times/week: OR 1.88, 95% CI 1.34 ~ 2.67) and a preference for meat over vegetables were associated with higher morbidity odds. Conclusion: Specific dietary patterns, particularly plant-based foods and tea, are inversely associated with morbidity burden in radiation workers. These findings support integrating tailored nutritional guidelines into occupational health frameworks to improve health outcomes among radiation workers.

Background: Occupational noise exposure has been linked to various adverse health outcomes, including metabolic disorders. However, limited evidence exists regarding its association with metabolic dysfunction-associated fatty liver disease (MAFLD). This study aimed to investigate the association between occupational noise exposure and MAFLD among automotive manufacturing workers, providing scientific evidence for the prevention and management of MAFLD in occupational populations. Methods: A cross-sectional study involving 3,427 male workers from two automobile manufacturing enterprises in Guangzhou, China, was conducted in 2023. Individual occupational noise exposure levels were assessed via cumulative noise exposure (CNE). MAFLD was diagnosed on the basis of ultrasound imaging and metabolic criteria, including obesity, type 2 diabetes, or metabolic dysregulation. Logistic regression models were used to evaluate the associations between CNE and MAFLD, adjusting for demographic, lifestyle, and clinical covariates. The interaction effects of shift work and hearing protection device use were analyzed. Mediation analysis was used to assess the role of body mass index (BMI) in the relationship between CNE and MAFLD. Results: According to the continuous models, each 1 dB-year increase in the CNE was associated with a 1.05-fold increased risk of MAFLD (OR: 1.05, 95% CI: 1.02, 1.08). According to the categorical models, workers in the highest CNE quartile (>89.651 dB-years) had a significantly greater risk of MAFLD (OR: 1.50, 95% CI: 1.05, 2.16) than did those in the lowest quartile. Subgroup analyses revealed that the association was more pronounced among workers who did not use hearing protection devices or worked night shifts ( p for interaction<0.01). Body mass index (BMI) partially mediated the association between CNE and MAFLD, accounting for 3.48% of the total effect. Conclusion: Occupational noise exposure was associated with higher odds of MAFLD, and BMI partially mediated this association. Night/shift work and hearing protection use affect this relationship. These findings emphasize the need for effective noise control and occupational health interventions to mitigate MAFLD risk among workers exposed to noise.

Background: Acute paraquat (PQ) poisoning is associated with high mortality and rapid multi-organ injury. Early risk stratification is particularly important when plasma or urine PQ concentrations are unavailable. This study aimed to characterize acute PQ poisoning and identify routinely available admission variables associated with in-hospital death. Methods: We retrospectively enrolled 128 consecutive patients with acute PQ poisoning admitted to Guangzhou Twelfth People’s Hospital between January 2008 and December 2020. Patients were categorized as survivors ( n = 46) or non-survivors ( n = 82) according to in-hospital outcome. Continuous variables were analyzed using the Mann–Whitney U test and categorical variables using the chi-square test or Fisher’s exact test, as appropriate. Clinically relevant admission variables were screened for collinearity and entered into a backward stepwise binary logistic regression model in SPSS 25.0. ROC curves were generated in R, and AUCs with 95% confidence intervals were calculated. Results: The in-hospital mortality rate was 64.06%. Compared with survivors, non-survivors had significantly higher ingested dose, coagulation indices, inflammatory markers, liver injury markers, renal function indices, and myocardial injury markers (all p < 0.05). In multivariable analysis, ingested dose (OR = 1.016, 95% CI: 1.003–1.029, p = 0.015) and AST (OR = 1.027, 95% CI: 1.011–1.042, p = 0.001) were independently associated with in-hospital death. AST showed the best discrimination among single markers (AUC = 0.911, 95% CI: 0.855–0.958). Conclusion: Ingested dose and AST were independently associated with in-hospital death in acute PQ poisoning, and AST showed the best single-marker discriminative performance.

Introduction: Paraquat (PQ) and diquat (DQ) are highly toxic bipyridyl herbicides, but their dominant organ injury patterns and clinical outcomes are not identical. This study aimed to compare the clinical characteristics, organ injury profiles, and prognosis of acute PQ and DQ poisoning. Methods: This retrospective single-center cohort study included consecutive patients with acute oral PQ or DQ poisoning treated at Guangzhou Occupational Disease Prevention and Treatment Hospital between January 2012 and January 2022. Baseline characteristics, clinical manifestations, admission laboratory findings, and in-hospital outcomes were compared between 270 patients with PQ poisoning and 115 patients with DQ poisoning. Results: PQ poisoning was associated with a higher crude in-hospital mortality rate than DQ poisoning (142/270 [52.6%] vs. 29/115 [25.2%], p < 0.001), shorter hospital stay, higher admission creatinine levels, and more frequent mediastinal emphysema. In contrast, DQ patients were younger, reported larger ingestion amounts, presented later to the local hospital, and more often showed nausea/vomiting, disturbance of consciousness, seizures, reduced responsiveness, agitation, dysarthria, anuria, and pleural effusion. The DQ group also had significantly higher CK and CK-MB levels, suggesting more prominent neuromuscular involvement. Kaplan–Meier analysis showed a significant difference in overall survival between the two groups. Conclusion: PQ and DQ poisoning show distinct clinical phenotypes and should not be managed as interchangeable toxic syndromes. Rapid toxin identification and toxin-specific monitoring may help guide early risk stratification and supportive care.

The deep integration of social media into daily routines has intensified concerns about problematic social media use among students, adversely affecting both educational outcomes and psychological well-being. Drawing on Social Cognitive Theory and Cognitive-behavioral Theory, this study investigates the roles of academic pressure, anxiety, and depression in the development of social media addiction, with particular attention to the mediating effect of self-control and the moderating role of social support. A survey of 900 college students collected data on these key variables. Structural equation modeling revealed that: academic pressure, anxiety, and depression directly increase social media addiction while also reducing self-control, which mediates the associations. Social support weakens the relationship between academic pressure and social media addiction, yet it fails to significantly moderate the link between anxiety and social media addiction. These findings reveal a multi-layered mechanism underlying social media addiction and provide valuable guidance for intervention strategies in higher education contexts.

Introduction: 1,2-Dichloroethane (1,2-DCE) is a highly toxic industrial organic solvent that can cause acute toxic encephalopathy through occupational exposure, with underreported clinical data in English literature. To explore the clinical characteristics and patients’ response to supportive treatments of toxic encephalopathy caused by 1,2-DCE. Methods: Fifty-nine patients with acute 1,2-DCE poisoning admitted to the hospital from January 2009 to December 2022 were selected. Patients were divided into three groups based on clinical manifestations: intracranial hypertension (Group A), limb tremors (Group B), and behavioral changes (Group C). Results: Toxicology testing found that 1,2-DCE was difficult to detect in serum after more than 24 h. Of the 59 patients, 45 (76.27%) achieved complete recovery, 10 (16.95%) achieved partial recovery, and 4 (6.78%) died. Statistical analysis showed a significant difference in recovery rates among the three groups (χ ² = 10.612, P < 0.05). There were no statistically significant differences in symptom and cranial imaging recovery times between the three groups. Conclusion: Acute 1,2-DCE poisoning can cause severe toxic encephalopathy. Early and prolonged treatment with dehydrating agents and glucocorticoids is effective in improving prognosis, and patients with intracranial hypertension are at higher risk of death due to brain herniation.